Coeliac sprue

(also called idiopathic steatorrhoea or coeliac disease), gluten-induced enteropathy, characterized by malabsorption due to lesions of the small intestine caused by certain cereals in the diet. Histology reveals flattening, broadening coalescence and sometimes complete loss of villi. The lamina propria is infiltrated by lymphocytes, plasma cells and occasionally eosinophils. The epithelial cells are flattened. These mucosal abnormalities tend to be more prominent in the jejunal loops than in the ileum.

Barium study reveals dilatation of the lumen of the mid and distal jejunum as well as flattening and thinning of mucosal folds (Fig.1). Dilatation of the distal ileum is not common. Another feature is segmentation of the barium column: masses of barium are separated from adjacent clumps and are usually situated in dilated loops that contain excessive amounts of fluid. The mucosal folds appear straightened and less prominent and thinned. The absence of the valvulae conniventes is secondary to the increased fluid content and has been termed the "moulage" sign. The hypotony of the intestinal wall may lead to coalescence of the walls of the bowel and to nonobstructive intussusception. These intermittent intussusceptions present a coiled spring pattern on barium studies and involve short segments of the bowel. In advanced stage of coeliac disease, the duodenal and jejunal folds become more and more rarefied and may almost become undetectable. Involvement of the ileum usually occurs late in the disease. The association of rarefied jejunal folds with thickening of the ileal folds has been termed the "inverted bowel" pattern.